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Galteri G, Montanari S, Dozza G, Palanca M, Cristofolini L. Short humeral stem in total shoulder arthroplasty does not jeopardize primary implant stability. JSES Int 2025; 9:212-218. [PMID: 39898196 PMCID: PMC11784511 DOI: 10.1016/j.jseint.2024.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025] Open
Abstract
Background The trend of the modern humeral components in total shoulder arthroplasty is toward shorter and shorter humeral stems. However, the question remains whether short uncemented stems can provide the same implant stability as long stems. This study aimed to evaluate and compare the torsional primary stability and the pull-out extraction force of both a long and a short version of the same stem. Materials and methods Ten humeral components (five long stems and five short stems) were press-fitted into ten synthetic composite humeri. A torsional load was applied to generate the most critical loading condition. The specimens were loaded with 100 cycles between 2 Nm and 10 Nm, at 1 Hz. A 3D Digital Image Correlation system was used to measure the relative displacement between the prosthesis and the host bone during the test. After completing the torsional test, the pull-out force was measured. Differences between the long and short stem on the biomechanical parameters (permanent migrations, inducible micromotion, and extraction force) were tested with the nonparametric Mann-Whitney test (P < .05). Results The main rotational inducible micromotion was around the craniocaudal axis. No significant differences were found between the rotational permanent migrations of the long and short stem around the craniocaudal (P = .421), anteroposterior (P = .841), and mediolateral axes (P = .452). No significant differences were found between the rotational inducible micromotions of the long and short stem around the craniocaudal (P = .222), anteroposterior (P = .420), and mediolateral axes (P = .655). No significant differences were found between the permanent translations of the long and short stem along the craniocaudal (P = .341), anteroposterior (P = .420), and mediolateral (P = .429) directions. No significant differences were found between the translations of the long and short stem in terms of inducible translation in the craniocaudal (P = .547), anteroposterior (P = .999), and mediolateral axes (P = .285). Similar extraction force (P = .35) was found. Discussion and Conclusion No statistically significant difference was found between the long-stem and short-stem implants. These results show that short uncemented stems can provide adequate primary mechanical stability. As the long-stem version of this stem is already clinically used, the present findings suggest that the short version can be reasonably expected to deliver similar outcomes in terms of implant stability.
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Affiliation(s)
- Giulia Galteri
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Sara Montanari
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Giacomo Dozza
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Marco Palanca
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Rankin IA, Goffin J, Khan LAK, Cairns D, Barker SL, Kumar K. Stress shielding of the proximal humerus in stemless anatomic total shoulder arthroplasty. Shoulder Elbow 2024; 16:493-500. [PMID: 39464830 PMCID: PMC11512461 DOI: 10.1177/17585732231168391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/19/2023] [Indexed: 10/29/2024]
Abstract
Background This study aimed to assess the radiographic proximal humerus bony adaptations to stress shielding and associated clinical outcomes following stemless total shoulder arthroplasty. Methods A retrospective review of all patients who underwent stemless total shoulder arthroplasty surgery at our centre from 2010 to 2020 was performed. Results In total, 115 stemless total shoulder arthroplasty utilising a single implant design with a minimum one-year follow-up were identified over a 10-year period. The median follow-up was 3.5 years (range: 1-8.9 years). Evidence of stress shielding was observed in 20 cases (17%), (9 mild (8%), 0 moderate (0%), 11 severe (9%). No significant differences were seen between stress shielding and gender, body mass index, post-operative range-of-motion, patient satisfaction, or Oxford shoulder score. No significant differences were seen between the operative technique and stress shielding. No cases had evidence of humeral lucency. In total, 24 cases (21%) had evidence of glenoid lucency of Lazarus grade 0-3. No cases had Lazarus grades 4 or 5. There was no association between stress shielding and humeral lucency, glenoid lucency, or revision procedure. Discussion Stress shielding in this study occurred at lower rates than anticipated following stemless total shoulder arthroplasty and was not associated with radiographic evidence of lucency, revision procedures, or adverse effect on clinical outcome measures.
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Affiliation(s)
- Iain A Rankin
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - Joaquim Goffin
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - L A Kash Khan
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - David Cairns
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - Scott L Barker
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
| | - Kapil Kumar
- Department of Trauma and Orthopaedics, Aberdeen Upper Limb Unit, Woodend Hospital, Aberdeen, UK
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Mathon P, Chivot M, Galland A, Airaudi S, Gravier R. Pyrolytic carbon head shoulder arthroplasty: CT scan glenoid bone modeling assessment and clinical results at 3-year follow-up. JSES Int 2023; 7:2476-2485. [PMID: 37969536 PMCID: PMC10638580 DOI: 10.1016/j.jseint.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The aim of this study is to report the radiological glenoid modifications and clinical outcomes at 3 years mean follow-up of hemi shoulder arthroplasty (HA) with pyrocarbon (PYC) humeral head. Our hypothesis was that the PYC implants would provide good outcomes without major glenoid erosion. Additionally, we hypothesized that HA-PYC allowed for remodeling of the bone. Methods Patients underwent HA with PyC humeral head for treatment of primary or secondary osteoarthritis, excluding post-traumatic cases. All patients had a Constant Score assessed preoperatively and at the last follow-up. Preoperative and postoperative computed tomography scans at the last follow-up were performed to achieve 3-dimensional reconstructions of the scapulae. Deformities of the glenoid surface were analyzed as a distance differential between postoperative and preoperative to investigate potential bone remodeling vs. glenoid erosion. The subluxation index (SLI) was measured. Results We included 41 patients implanted with a HA-PYC. Average age at the time of implant was 63.8 (40 to 79 years). All patients were followed for ≥2 years with an average follow-up of 36.3 months (24 to 60 months). Constant Scores increased from 34 at baseline to 80 at the last follow-up points on average (P < .01). Return to work rate was 100% and 96% had resumed their physical activity. Ten (77%) of the 13 patients with posterior head subluxation had normalized their SLI. Furthermore, no significant differences were detected between the individuals having corrected their posterior subluxation and the others (preoperative SLI between 0.45 and 0.55). Glenoid wear is less than 0.6 mm at 3 years mean follow-up, ie, 5 times less than metallic implants. A tendency to recenter the head in the anteroposterior plane was found in type B glenoid, without increased erosion of the glenoid, with very good clinical results. We did not find any difference according to age or glenoid type for clinical and radiological results. Conclusion HA-PYCs give, in the short term, excellent clinical results in terms of pain and function. The development of a precise and objective measurement method has made it possible to demonstrate that the glenoid surface is the site of modifications that may be part of bone remodeling or progression of the osteoarthritis disease.
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Affiliation(s)
- Pauline Mathon
- Aix-Marseille University, CNRS, ISM UMR 7287, Marseille 13288, France
| | - Matthieu Chivot
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Hopital Privé Clairval (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
| | - Alexandre Galland
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
| | - Stéphane Airaudi
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
| | - Renaud Gravier
- Clinique Monticelli-Vélodrome (Groupe Ramsay Santé), Marseille, France
- Institut de la Main et du Membre Supérieur (IMMS), Marseille, France
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Cochrane E, Vollans S, Bourke G. Brachial plexus deficits in patients undergoing shoulder arthroplasty. Shoulder Elbow 2023; 15:65-70. [PMID: 37692871 PMCID: PMC10492527 DOI: 10.1177/17585732221089299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/28/2022] [Accepted: 03/01/2022] [Indexed: 09/12/2023]
Abstract
Background Nerve deficit following shoulder arthroplasty can cause significant morbidity. We examined the incidence and pattern of nerve injury following shoulder arthroplasty in a University Hospital. Methods Retrospective review of all patients undergoing shoulder arthroplasty over a five-year period (September 2014 to August 2019). Patients were identified using clinical codes and relevant data extracted by review of patient records. We excluded patients with preoperative nerve injuries. Results 220 arthroplasties were performed in 210 patients. The overall nerve deficit rate was 2.3% (5/220). Five nerve deficits occurred following reverse total shoulder arthroplasty (rTSA). In two patients, nerve recovery occurred within 12 months. Two patients had persistent deficits at 12 months. One patient had a deficit at seven months, but incomplete follow up. There was no clear documentation of discussions with clinicians specialising in nerve injury. Conclusion Nerve injury rates in our series for rTSA are low and comparable to systematic review data. We purport that for rTSA, adequate soft tissue releases, careful arm positioning and retraction alongside limiting over-lowering the centre of rotation may prevent nerve injuries. A postoperative nerve deficit should warrant an opinion from a specialist in nerve surgery with clear referral pathways to allow efficient access to services.
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Affiliation(s)
- Elliott Cochrane
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Sam Vollans
- Department of Trauma & Orthopaedic Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Gráinne Bourke
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals, Leeds, UK
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK
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Churchill JL, Paez CJ, Entezari V, Ricchetti ET, Ho JC. Understanding Medical Optimization for Patients Undergoing Shoulder Arthroplasty. Orthop Clin North Am 2023; 54:309-318. [PMID: 37271559 DOI: 10.1016/j.ocl.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Many surgeons seek to optimize their patients' comorbid conditions preoperatively to reduce postoperative complications. To effectively optimize patients before total shoulder arthroplasty, the surgeon should be familiar with recognizing and treating common medical comorbidities found in an orthopedic patient including anemia, diabetes, malnutrition, cardiovascular conditions, and history of deep venous thrombosis. Screening for depression or other mental illness should also be conducted preoperatively and managed accordingly before surgery. Preoperative opioid use and smoking have significant effects on postoperative outcomes and should be addressed before surgery.
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Affiliation(s)
- Jessica L Churchill
- Cleveland Clinic Foundation, Department of Orthopaedic Surgery, A40, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Conner J Paez
- Cleveland Clinic Foundation, Department of Orthopaedic Surgery, A40, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Vahid Entezari
- Cleveland Clinic Foundation, Department of Orthopaedic Surgery, A40, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Eric T Ricchetti
- Cleveland Clinic Foundation, Department of Orthopaedic Surgery, A40, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jason C Ho
- Cleveland Clinic Foundation, Department of Orthopaedic Surgery, A40, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Chawla L, Kumar K, Barker S, Ismail A. Restoration of the joint geometry after stemless shoulder arthroplasty. Shoulder Elbow 2023; 15:321-327. [PMID: 37325383 PMCID: PMC10268137 DOI: 10.1177/17585732221088999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 09/20/2023]
Abstract
Aim This study aims to evaluate restoration of anatomy following Total Shoulder Arthroplasty (TSA) with the Mathys Affinis Short prosthesis. Background Over the last decade stemless shoulder arthroplasty has increased in popularity. One of the reported advantages of the stemless designs is the ability to restore anatomy following surgery. However, very few studies have evaluated restoration of anatomy following stemless shoulder arthroplasty. Methods The study included all patients who had undergone TSA using the Affinis Short (Mathys Ltd, Bettlach, Switzerland) prosthesis for primary osteoarthritis between 2010 and 2016. The mean follow up was 42.8 months (range 9.4 to 83.4 months). Pre and post-operative radiographs were assessed for Centre of Rotation (COR), Humeral Head Height (HHH), Humeral Head Diameter (HHD), Humeral Height (HH) and, Neck Shaft Angle (NSA) using the best fit circle method on PACS software. Measurements were scored and compared to assess the accuracy of the implant in restoring the native geometry, including the intraobserver variability. The same data was collected by another experienced observer to measure the interobserver variability. Results The deviation of COR of the prosthesis from the anatomical centre was less than 3 mm in 58 cases (85%). Humeral head height and humeral head diameter showed a variation of less than 3 mm in 66 cases (97%) and 43 cases (63%) respectively. Humeral height followed a similar trend, with 62 cases (91.2%) showing a difference of less than 5 mm. The neck shaft angle showed a variation of more than 8 degrees in 38 cases (55%), and 29 cases (42.6%) had a postoperative angle of less than 130 degrees. Conclusion Overall, stemless total shoulder arthroplasty with the Affinis Short prosthesis allows excellent restoration of anatomy confirmed by most of the measured radiographic parameters. The variability in neck shaft angle might be due to differing surgical techniques, with some surgeons preferring a slightly vertical neck cut to protect the rotator cuff insertion.
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Raval P, Deore V, Bishnoi A, Armstrong A, Modi A, Pandey R. Mid-term results for a stemless anatomical total shoulder replacement, with a ceramic head, for glenohumeral osteoarthritis. Shoulder Elbow 2023; 15:283-291. [PMID: 37325387 PMCID: PMC10268144 DOI: 10.1177/17585732211058725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 09/20/2023]
Affiliation(s)
- P Raval
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - V Deore
- Department of Trauma and Orthopaedics, The Mid Yorkshire Hospital NHS Trust, UK
| | - A Bishnoi
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - A Armstrong
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - A Modi
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
| | - R Pandey
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester, UK
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Baker HP, Gutbrod J, Strelzow JA, Maassen NH, Shi L. Management of Proximal Humerus Fractures in Adults-A Scoping Review. J Clin Med 2022; 11:6140. [PMID: 36294459 PMCID: PMC9604576 DOI: 10.3390/jcm11206140] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Proximal humerus fractures are the third most common fracture type in adults, with their incidence increasing over time. There are varied approaches to both the classification and treatment of proximal humerus fractures. Optimal treatments for this fracture type are still widely open to debate. This review summarizes the current and historical treatment modalities for proximal humerus fractures. In this paper, we provide updates on the advances and trends in the epidemiology, classification, and operative and nonoperative treatments of proximal humerus fractures.
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Affiliation(s)
- Hayden P. Baker
- The University of Chicago, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Duchossois Center for Advanced Medicine, MC 3079, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL 60637, USA
| | | | | | | | - Lewis Shi
- The University of Chicago, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Duchossois Center for Advanced Medicine, MC 3079, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL 60637, USA
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9
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The 50 Highest Cited Papers on Shoulder Arthroplasty. Healthcare (Basel) 2022; 10:healthcare10102000. [PMID: 36292447 PMCID: PMC9602479 DOI: 10.3390/healthcare10102000] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 11/04/2022] Open
Abstract
The purpose of this study was to determine the 50 most cited articles on shoulder arthroplasty (SA) and their characteristics. The Thomson ISIWeb of Science was searched with the following search terms: "shoulder arthroplasty", "shoulder replacement", "shoulder prosthesis" and "shoulder implant". All papers dealing with SA, including its perioperative and postoperative management, were included in this study. Citations ranged from 797 to 52 for the 50 highest cited papers on SA. According to absolute numbers, the top 10 papers were cited at least 118 times. Overall, 78% (n = 43) were clinical and the remaining articles were basic science research (one anatomic, six biomechanical). The most prevalent level of evidence was IV (72%). The Journal of Shoulder and Elbow Surgery published 40% of the studies. The majority of studies were conducted in the United States and eight other countries. The publication years of the most-cited articles ranged from 1991 to 2020, with the 2000s accounting for the most articles (96%) and the period from 2006 to 2010 with the absolute largest number of articles (17). This article provides a building block in the SA surgery.
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10
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Imiolczyk JP, Krukenberg A, Mansat P, Bartsch S, McBirnie J, Gotterbarm T, Wiedemann E, Soderi S, Scheibel M. Midterm results of stemless impaction shoulder arthroplasty for primary osteoarthritis: a prospective, multicenter study. JSES Int 2022; 7:1-9. [PMID: 36820431 PMCID: PMC9937825 DOI: 10.1016/j.jseint.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Stemless shoulder arthroplasty using 4 open-fin press-fit anchors has been showing promising short-term clinical and radiographic results for patients' primary osteoarthritis. This prospective, multicenter study presents 5-year postoperative clinical and radiological outcomes of a stemless shoulder arthroplasty for primary osteoarthritis. Methods Between November 2012 and December 2015, 100 patients were treated for primary osteoarthritis with the Sidus stem-free shoulder system at 7 European centers. Clinical assessment included the Constant-Murley Score, American Shoulder and Elbow Standardized Shoulder Assessment Form score, Subjective Shoulder Value, and range of motion. True anteroposterior, axial and lateral radiographs were reviewed for osteolysis, glenoid and humerus loosening, heterotopic ossification, radiolucent lines, component migration and humeral bone resorption. In addition to a Kaplan-Meier survival analysis, a comparative analysis between total shoulder arthroplasty and hemiarthroplasty was performed. Results Seventy-one patients (36 females) with a mean age of 63.8 years (range: 47-79 years) were available for the 5-year clinical and radiographic follow-up (range: 52-79 months). There was a significant increase (P < .0001) in all outcome scores compared to baseline values. Patients with total shoulder arthroplasty (n = 48) achieved significantly better functional outcome than patients with shoulder hemiarthroplasty (n = 23) with regard to the absolute and relative Constant-Murley Score, American Shoulder and Elbow Standardized Shoulder Assessment Form score, and Subjective Shoulder Value as well as greater abduction strength and range of motion in forward elevation and external rotation (P ≤ .004). There were no cases of osteolysis or humeral loosening. There were some cases of heterotopic ossification (1.4%), radiolucency around the humerus (1.4%) or glenoid (25%), glenoid migration (2.1%), inferior osteophytes (1.4%) or humerus bone resorption (9.9%). The 5-year survival was 94%. Conclusion Patients treated with the Sidus stem-free shoulder system for primary osteoarthritis continue to achieve good clinical and radiographic results without any signs of aseptic humeral implant loosening at 5 years postsurgery.
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Affiliation(s)
| | - Anna Krukenberg
- Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Germany
| | - Pierre Mansat
- Centre Hospitalier Universitaire Toulouse, Hôpital Purpan, Toulouse, France
| | | | - Julie McBirnie
- Department of Orthopaedics, New Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Austria
| | | | - Stefano Soderi
- Orthopedic Clinic, Department of NeuroMuscoloSkeletal and Sense Organs, Azienda Ospedaliero Universitaria Careggi, Centro Traumatologico Ortopedico, Florence, Italy
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Germany,Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland,Corresponding author: Markus Scheibel, MD, Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité – Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Prior Nonshoulder Periprosthetic Joint Infection Increases the Risk of Surgical Site Infection, Sepsis, and All-Cause Revision After Primary Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:133-139. [PMID: 34921545 DOI: 10.5435/jaaos-d-21-00745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/03/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) after total joint arthroplasty is a known risk factor for infection in subsequent joint arthroplasty. The purpose of this study was to determine whether prior nonshoulder PJI contributes to the increased risk of infectious complications, greater healthcare utilization, and increased revision surgery after primary total shoulder arthroplasty (TSA). METHODS Patients who underwent primary TSA for osteoarthritis with prior nonshoulder PJI were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were propensity matched based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index >30 kg/m2) to a control cohort of patients who underwent primary TSA for osteoarthritis without any prior PJI. Primary outcomes include 1- and 2-year revision rates. Secondary outcomes include healthcare-specific outcomes of readmission, emergency department visits, length of stay, and mortality. Bivariate analysis was conducted using chi-square tests to compare all outcomes and complications between both cohorts. RESULTS Compared with patients without prior PJI, those with prior PJI had a significantly higher risk of 90-day surgical site infection (7.61% versus 0.56%) and sepsis (1.79% versus 0.56%) after TSA (P < 0.05 for both). Patients with prior PJI also had a higher risk of 90-day readmission compared with those without prior PJI (3.36% versus 1.23%, P = 0.008). In terms of surgical complications, patients with prior PJI had significantly higher risk of 2-year revision surgery compared with patients without prior PJI (3.36% versus 1.57%, P = 0.034). CONCLUSION Prior nonshoulder PJI of any joint increases rates of 90-day surgical site infection, sepsis, and hospital readmission, as well as 2-year all-cause revision after TSA. These results are important for risk-stratifying patients undergoing TSA with prior history of PJI. LEVEL OF EVIDENCE III.
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Lafosse L, Protais M, Moody MC, Colas M, Puah KL, Lafosse T. Live Surgery: A retrospective study on the outcomes and complications of 7 orthopedic live surgery events. Orthop Traumatol Surg Res 2021; 107:102871. [PMID: 33639289 DOI: 10.1016/j.otsr.2021.102871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Live surgery has always been an invaluable part of medical education. Live Surgery Events (LSE) have recently been criticized in France, arguing that unnecessary risks have been placed on the patients. HYPOTHESIS We want to report our experience in organizing the last 7 shoulder LSE over the past 12 years focusing on the results and complications during and after the surgeries performed during these courses. MATERIAL AND METHODS 190 patients benefited from live shoulder surgery between 2005 and 2017. 11 of them were lost to follow up, thus 179 patients were included. The mean follow-up was 7,5 years for the instability group, 6,7 years for the rotator cuff group, 7,5 years for the arthroplasty group and 6,8 years for the nerve group. This study is a retrospective analysis of prospectively collected data. We report the epidemiology of the surgeries perfomed and analyzed the patient outcomes: peri and postoperative complications. We evaluated the educational benefit for the attendees of this shoulder LSE through a questionnaire. RESULTS There were 6 (3.1%) peri or immediate postoperative complications. There were 33 (18%) long term complications needing 26 (14%) revisions. 90% of the surgeons audience attending the events evaluated the educational benefit from good to very good. DISCUSSION Over the years, we have standardized the organization of the meeting to ensure maximum safety, while still respecting patient integrity and anonymity. Our complications rates seem within the ranges found in the current literature for each procedure. Our LSE has been an instrument for education, but also for matching patients with complex problems with experienced surgeons, to the benefit of the patient. Our experience has shown that LSE may induce potential dangers and complications can arise. However, these events should follow rigorous rules and not just recommendations. LEVEL OF EVIDENCE IV; retrospective analysis of prospectively collected data.
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Affiliation(s)
- Laurent Lafosse
- Alps surgery institute: hand, upper limb, brachial plexus, and microsurgery unit (PBMA), clinique générale d'Annecy, 4, chemin de la Tour la Reine, 74000 Annecy, France
| | - Marie Protais
- Department of orthopedics and traumatology-service of hand and upper limb, Saint Antoine hospital, Assistance Publique-hôpitaux de Paris (AP-HP), 184, rue du faubourg Saint Antoine, 75012, Paris, France.
| | - M Christian Moody
- Department of Hand, upper extremity and microsurgery, Prisma Health System, Greenville, SC, USA
| | - Manon Colas
- Department of Orthopedics and Traumatology-Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique-Hôpitaux de Paris (APHP), 20, rue Leblanc, 75015 Paris, France
| | - Ken Lee Puah
- Department of Orthopaedic Surgery, Singapore General Hospital, 20, College Road, Academia, Level 4 169856, Singapore
| | - Thibault Lafosse
- Alps surgery institute: hand, upper limb, brachial plexus, and microsurgery unit (PBMA), clinique générale d'Annecy, 4, chemin de la Tour la Reine, 74000 Annecy, France; Department of Orthopedics and Traumatology-Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique-Hôpitaux de Paris (APHP), 20, rue Leblanc, 75015 Paris, France
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13
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Wixted CM, Goltz DE, Wickman JR, Levin JM, Lassiter T, Klifto C, Anakwenze O. Intraoperative fractures in shoulder arthroplasty: risk factors and outcomes. JSES Int 2021; 5:1021-1026. [PMID: 34766079 PMCID: PMC8569010 DOI: 10.1016/j.jseint.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of shoulder arthroplasty in the United States continues to increase, and while the risk of intraoperative complications such as fracture remains relatively low, there has been little investigation into whether certain patient-specific risk factors predispose to this complication. This study characterizes the incidence of intraoperative fracture during shoulder arthroplasty and additionally hypothesizes that certain risk factors may exist in addition to potentially leading to worsened near-term outcomes. Methods An institutional database of shoulder arthroplasties (N = 1773; 994 anatomic, 779 reverse) was retrospectively reviewed, and the operative reports for each case were examined for documentation of an intraoperative fracture, including during which surgical step the fracture took place. Various preoperative and intraoperative factors were tested for comparative significance (P < .05) using chi-square and Kruskal-Wallis tests as appropriate. Length of stay, 90-day readmission, and discharge to rehabilitation or skilled nursing facility (SNF) were further examined as secondary outcomes. Results Twenty-one (1.2%) intraoperative fractures were documented, a majority of which occurred in reverse shoulder arthroplasties compared to anatomic procedures (overall incidence: 2.5% vs. 0.2%, P < .001). These most commonly occurred during either stem broaching (33%) or seating (33%) and were most likely to involve the metaphysis (53%) or greater tuberosity (33%). Five fractures occurred during revision arthroplasty, while 16 fractures occurred during primary procedures (overall incidence: 3.0 vs. 1.0%, P = .03). Patient factors reaching statistical significance included female gender and liver disease, while age and smoking history were notably not associated with intraoperative fracture. The fracture cohort had a significantly longer mean length of stay (2.42 vs. 2.17 days, P < .001). While the rates of 90-day readmission and discharge to SNF/rehab were higher in the fracture cohort, these values did not reach statistical significance. Conclusion Intraoperative fractures are a rare complication (1.2%) in shoulder arthroplasty, with reverse shoulder arthroplasty, revision cases, and female gender associated with an elevated overall risk. While these patients had a longer inpatient hospitalization, the substantially higher rates of 90-day readmission and discharge to SNF/rehab did not reach significance in our limited institutional cohort. The aforementioned incidence and risk factors serve as crucial evidence for use during the preoperative counseling process with patients as part of a shared decision-making model.
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Affiliation(s)
| | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - John R Wickman
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Tally Lassiter
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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14
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Zhang B, Niroopan G, Gohal C, Alolabi B, Leroux T, Khan M. Glenoid bone grafting in primary anatomic total shoulder arthroplasty: a systematic review. Shoulder Elbow 2021; 13:509-517. [PMID: 34659484 PMCID: PMC8512982 DOI: 10.1177/1758573220917653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/12/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. METHODS A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. RESULTS Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. CONCLUSION Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Betty Zhang
- DeGroote School of Medicine,
McMaster
University, Hamilton, Canada
| | - Gavinn Niroopan
- Department of Surgery,
McMaster
University, Hamilton, Canada
| | - Chetan Gohal
- Department of Surgery,
McMaster
University, Hamilton, Canada
| | - Bashar Alolabi
- Department of Surgery,
McMaster
University, Hamilton, Canada
| | - Timothy Leroux
- Department of Surgery,
University
of Toronto, Toronto, Canada
| | - Moin Khan
- Department of Surgery,
McMaster
University, Hamilton, Canada,Moin Khan, St Joseph’s Healthcare Hamilton,
Mary Grace Wing, Room G807, 50 Charlton Ave E., Hamilton, ON L8N 4A6, Canada.
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15
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Willenbring TJ, DeVos MJ, Kozemchak AM, Warth RJ, Gregory JM. Is outpatient shoulder arthroplasty safe in patients aged ≥65 years? A comparison of readmissions and complications in inpatient and outpatient settings. J Shoulder Elbow Surg 2021; 30:2306-2311. [PMID: 33753272 DOI: 10.1016/j.jse.2021.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent studies indicate that outpatient total shoulder arthroplasty (TSA) is cost-effective and may have a low complication rate similar to inpatient TSA. However, existing studies have included younger patient cohorts who typically possess fewer medical comorbidities. Patients aged ≥65 years are commonly enrolled in Medicare, which has traditionally designated TSA as an inpatient-only procedure. The purpose of this study was to compare surgical complication rates and 90-day readmission rates between inpatient and outpatient TSA performed in adults aged ≥65 years. METHODS Medical records for all patients aged ≥65 years who underwent primary anatomic or reverse TSA by a single surgeon from July 2015 to May 2020 were reviewed. Patients were preselected for outpatient or inpatient surgery based on lack of significant cardiopulmonary comorbidities and patient preference. Demographics, body mass index (BMI), and American Society of Anesthesiologists (ASA) scores were collected in addition to emergency department (ED) visits and readmissions within 90 days of the index surgery. Relationships among frequency and types of complications and surgical setting (inpatients vs. outpatient) were assessed. Complication rates and demographic variables between inpatient and outpatient procedures were compared. Logistic regressions were performed to account for interacting predictor variables on the odds of having complications. RESULTS A total of 145 shoulders (138 patients; 95 male, 43 female) were included in the analysis, of which 98 received inpatient TSA and 47 received outpatient TSA. Average age was 75.5 ± 7.2 for inpatient TSA and 70.5 ± 4.5 for outpatient TSA (P < .001). Patient age (P < .001), ASA score ≥3 (P < .001), and reverse TSA (P = .002) were significantly positively correlated with receiving inpatient surgery. There were 16 complications (16.3%) in the inpatient group and 9 complications (19.1%) in the outpatient group (P = .648). There were no significant differences in the frequency of postoperative complications, return to the ED, or reoperations between inpatient and outpatient procedures (P > .05). Each 1-year increase in age increased the predicted odds of having a surgical complication by 14% (odds ratio = 1.14; P = .021), irrespective of surgical setting. Those who underwent inpatient TSA had a significantly higher frequency of 90-day readmission (inpatient=16, outpatient=1; P = .034). CONCLUSIONS Postoperative complications and ED returns were not significantly different between inpatient and outpatient TSA. Each 1-year increase in age increased the odds of postoperative surgical complications by 14%, regardless of surgical setting. Outpatient TSA was found to be safe for appropriately selected patients aged ≥65 years, and re-evaluation of TSA as an inpatient-only procedure should be considered.
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Affiliation(s)
| | - Marijke J DeVos
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Adam M Kozemchak
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ryan J Warth
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - James M Gregory
- University of Texas Health Science Center at Houston, Houston, TX, USA.
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16
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Jordan RW, Kelly CP, Pap G, Joudet T, Nyffeler RW, Reuther F, Irlenbusch U. Mid-term results of a stemless ceramic on polyethylene shoulder prosthesis - A prospective multicentre study. Shoulder Elbow 2021; 13:67-77. [PMID: 33717220 PMCID: PMC7905519 DOI: 10.1177/1758573219866431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/09/2019] [Accepted: 07/05/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Early reports of stemless shoulder arthroplasty have shown promising clinical and radiological outcomes. The purpose of this study was to report on the mid-term results of an implant that utilises a ceramic humeral head. METHODS A prospective, consecutive, multicentre study of stemless shoulder prosthesis with a minimum of four years of follow-up was conducted between August 2009 and May 2012. The adjusted Constant-Murley Score (CMS), revision rate and presence of radiolucent lines were recorded at intervals. RESULTS A total of 207 patients were eligible for study inclusion; 62.8% were female and mean age was 64.8 years (range 30-86). Mean follow-up was 70.7 months (range 48-100), 73% underwent TSA and 27% hemiarthroplasty. The mean CMS improvement was 42.6 (p < 0.0001) at 48 months. Radiolucencies were present in 2.7% of humeral zones and 14% of glenoid zones at 48-month follow-up. The revision rate was 6.3% with rotator cuff failure (2.9%) the most common indication. CONCLUSIONS Mid-term results demonstrate that the studied stemless implant with a ceramic humeral head had clinical and radiological outcomes that are comparable to other reported studies.
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Affiliation(s)
- RW Jordan
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, England,RW Jordan, Robert Jones & Agnes Hunt Orthopaedic Hospital Gobowen, Oswestry SY10 7AG, England.
| | - CP Kelly
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, England
| | - G Pap
- Helios Park-Hospital Leipzig, Leipzig, Germany
| | - T Joudet
- Clinique du Libournais, Libourne, France
| | | | - F Reuther
- DRK Clinic Berlin Koepenick, Berlin, Germany
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17
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Willems JIP, Hoffmann J, Sierevelt IN, van den Bekerom MPJ, Alta TDW, van Noort A. Results of stemless shoulder arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:35-49. [PMID: 33532085 PMCID: PMC7845565 DOI: 10.1302/2058-5241.6.200067] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stemless shoulder arthroplasty relies solely on cementless metaphyseal fixation and is designed to avoid stem-related problem such as intraoperative fractures, loosening, stress shielding or stress-risers for periprosthetic fractures. Many designs are currently on the market, although only six anatomic and two reverse arthroplasty designs have results published with a minimum of two-year follow-up. Compared to stemmed designs, clinical outcome is equally good using stemless designs in the short and medium-term follow-up, which is also the case for overall complication and revision rates. Intraoperative fracture rate is lower in stemless compared to stemmed designs, most likely due to the absence of intramedullary preparation and of the implantation of a stem. Radiologic abnormalities around the humeral implant are less frequent compared to stemmed implants, possibly related to the closer resemblance to native anatomy. Between stemless implants, several significant differences were found in terms of clinical outcome, complication and revision rates, although the level of evidence is low with high study heterogeneity; therefore, firm conclusions could not be drawn. There is a need for well-designed long-term randomized trials with sufficient power in order to assess the superiority of stemless over conventional arthroplasty, and of one design over another. Cite this article: EFORT Open Rev 2021;6:35-49. DOI: 10.1302/2058-5241.6.200067
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Affiliation(s)
| | | | - Inger N Sierevelt
- Spaarne Gasthuis, Hoofddorp, The Netherlands.,Xpert Orthopedics, Amsterdam, The Netherlands
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18
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LaChaud GY, Schoch BS, Wright TW, Roche C, Flurin PH, Zuckerman JD, King JJ. Humeral stem lucencies correlate with clinical outcomes in anatomic total shoulder arthroplasty. JSES Int 2020; 4:669-674. [PMID: 32939504 PMCID: PMC7479044 DOI: 10.1016/j.jseint.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Humeral stem lucencies are uncommon after uncemented anatomic total shoulder arthroplasty (aTSA), and their clinical significance is unknown. This study compares clinical outcomes of aTSA with and without humeral stem lucencies. Methods Two-hundred eighty aTSAs using an uncemented grit-blasted metaphyseal-fit humeral stem between 2005 and 2013 were retrospectively evaluated for radiographic humeral stem lucencies. All shoulders were evaluated at a minimum 5-year follow-up from a multicenter database. Clinical outcomes included range of motion (ROM) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Constant score, University of California-Los Angeles Shoulder Score (UCLA), Simple Shoulder Test (SST), and Shoulder Pain and Disability Index (SPADI) scores. Postoperative radiographs were evaluated and complications were recorded. Results Two-hundred forty-three humeral stems showed no radiolucent lines. Among the 37 humeral stems with lucent lines, lines were most common in zones 8, 4, 7, and 3. Preoperative ROM and functional outcomes were similar between groups. Postoperative change in outcomes exceeded the minimal clinically important difference (MCID) for all ROM and outcomes in both groups. Postoperative change between groups showed no significant difference in ROM or outcome scores, but improved mean abduction exceeded the MCID in the patients without humeral lines. The complication rate after omitting patients with humeral loosening was higher in patients with humeral lucencies, as was the revision rate. There was also a higher glenoid-loosening rate in patients with humeral lucencies. Conclusion Humeral lucent lines after uncemented stemmed aTSA have a small negative effect on ROM and functional outcomes compared with patients without lucent humeral lines, which may not be clinically significant. The complication and revision rates were significantly higher in patients with humeral lucencies.
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Affiliation(s)
- Gregory Y LaChaud
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | | | - Joseph D Zuckerman
- NYU Center for Musculoskeletal Care, NYU Langone Medical Center, New York, NY, USA
| | - Joseph J King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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19
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Liu EY, Kord D, Horner NS, Leroux T, Alolabi B, Khan M. Stemless anatomic total shoulder arthroplasty: a systematic review and meta-analysis. J Shoulder Elbow Surg 2020; 29:1928-1937. [PMID: 32220527 DOI: 10.1016/j.jse.2019.12.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/12/2019] [Accepted: 12/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stemless anatomic total shoulder arthroplasty (TSA) is used in the treatment of osteoarthritis of the shoulder joint and other degenerative shoulder diseases. It has several proposed advantages over stemmed TSA including increased bone preservation, decreased operative time, and easier removal at revision. METHODS A systematic search was conducted using MEDLINE, Embase, PubMed, and CENTRAL (Cochrane Central Register of Controlled Trials) to retrieve all relevant studies. RESULTS The literature search yielded 1417 studies, of which 22 were included in this review, with 962 patients undergoing stemless TSA. Stemless TSA led to significant improvements in range of motion and functional scores in all included studies. Meta-analysis of comparative studies between stemless and stemmed TSA identified no significant differences in postoperative Constant scores (mean difference [MD], 1.26; 95% confidence interval [CI], -3.29 to 5.81 points; P = .59) or complication rates (odds ratio, 1.79; 95% CI, 0.71-4.54; P = .22). Stemless TSA resulted in a significantly shorter operative time compared with stemmed TSA (MD, -15.03 minutes; 95% CI, -23.79 to -6.26 minutes; P = .0008). Stemless TSA also resulted in significantly decreased intraoperative blood loss compared with stemmed TSA (MD, -96.95 mL; 95% CI, -148.53 to -45.36 mL; P = .0002). CONCLUSION Stemless anatomic TSA resulted in similar functional outcomes and complication rates to stemmed TSA with decreased operative time and lower blood loss. Further research is required to investigate the long-term durability of the stemless implant.
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Affiliation(s)
- Eva Y Liu
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dorsa Kord
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nolan S Horner
- Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | | | - Bashar Alolabi
- Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Moin Khan
- Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
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20
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Kholinne E, Altamimi LA, Aldayel A, AlSabti R, Kim H, Park D, Koh KH, Jeon IH. Primary Linked Total Elbow Arthroplasty for Acute Distal Humerus Fracture Management: A Systematic Review of Clinical Outcome. Clin Orthop Surg 2020; 12:503-513. [PMID: 33274028 PMCID: PMC7683186 DOI: 10.4055/cios20012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/18/2020] [Indexed: 12/21/2022] Open
Abstract
Backgroud The treatment of distal humerus fractures is often challenging in osteoporotic elderly patients. Total elbow arthroplasty (TEA) is a salvage option for non-reconstructable fractures. The aim of this systematic review was to evaluate the clinical evidence for primary TEA in patients with acute distal humeral fractures. Methods Literatures were searched through PubMed, Ovid/Medline, Cochrane, Google Scholar, and Embase databases with the keywords, “distal humerus fracture,” “total elbow arthroplasty,” and “outcome” according to the MeSH (Medical Subject Headings) index for English-language studies published from April 2009 to April 2019. We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results Ten articles with a total of 269 patients were included in the review. The Bryan-Morrey approach was the most common surgical approach (33.7%) with triceps reflecting (42%) for triceps tendon management. The most common implant design used was the Coonrad-Morrey system (83%). The mean postoperative motion arc was 102.3° for flexion-extension and 145.8° for pronation-supination. The average functional outcome score was 89.5 with Mayo Elbow Performance Score (MEPS). An excellent MEPS was found in studies with less than 7 days of average time from injury to surgery. The overall complication rate was 21.5%. Conclusions The current review showed favorable outcome of primary linked TEA for acute distal humerus fractures. Despite the promising functional outcomes, the complication rate was still considerably high. This systematic review will give surgeons help in explaining to patients regarding the expected outcome after primary TEA for acute distal humerus fractures.
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Affiliation(s)
- Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | | | - Aya Aldayel
- King Saud University College of Medicine, Riyadh, Saudi Arabia
| | - Razan AlSabti
- King Saud University College of Medicine, Riyadh, Saudi Arabia
| | - Hyojune Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dongjun Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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21
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Beck S, Patsalis T, Busch A, Dittrich F, Wegner A, Landgraeber S, Jäger M. Long-Term Radiographic Changes in Stemless Press-Fit Total Shoulder Arthroplasty. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:274-280. [PMID: 32097955 DOI: 10.1055/a-1079-6549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Stemmed humeral implants have represented the gold standard in total shoulder arthroplasty (TSA) for decades. Like many other joints, the latest trends in TSA designs aim at bone preservation. Current studies have demonstrated that native proximal humeral bone stresses are most closely mimicked by stemless implants. Nevertheless, there are concerns about the long-term performance of stemless designs. The aim of the present study was to evaluate the long-term radiographic changes at the proximal humerus in anatomical stemless press-fit TSA. MATERIALS AND METHODS Between 2008 and 2010, 48 shoulders in 43 patients were resurfaced using an anatomic stemless shoulder prosthesis (TESS, Biomet). Thirty shoulders in twenty-five patients who were aged 65.7 ± 9.9 (34 to 82) years were available for clinical and radiographic review at a mean follow-up of 94.0 ± 8.9 (78 to 110) months. RESULTS Radiographic changes of the proximal humerus due to stress shielding were found in 38.4% of the stemless TESS implants. Mild stress shielding accounted for 80% of the observed radiographic changes. Radiographs exhibited stable fixation of the stemless humeral press-fit implant at early and late follow-up. In contrast, radiolucent lines at the glenoid implant were found in 96.1% of the cases. Irrespective of the degree of radiographic changes, clinical scores (VAS, Quick-DASH, Constant score) significantly improved at follow-up. CONCLUSIONS The anatomic stemless press-fit implant seems to be favorable in terms of implant-related stress shielding. Clinical outcome was not affected by radiographic changes, demonstrating an 8-year clinical performance that seems to be comparable to conventional stemmed TSA.
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Affiliation(s)
- Sascha Beck
- Department of Orthopedics and Trauma Surgery, Universität Duisburg-Essen, Medizinische Fakultät, Essen.,Shoulder, Elbow, Knee and Trauma Surgery, Krankenhaus für Sportverletzte Hellersen, Lüdenscheid
| | - Theodor Patsalis
- Department of Shoulder, Elbow, Hand and Foot Surgery, Stiftung der Cellitinnen zur heiligen Maria Krankenhäuser Region Wuppertal, Wuppertal
| | - André Busch
- Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim, Contilia GmbH, Mülheim an der Ruhr
| | - Florian Dittrich
- Department of Orthopedics and Orthopedic Surgery, Universität des Saarlandes - Campus Homburg
| | - Alexander Wegner
- Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim, Contilia GmbH, Mülheim an der Ruhr
| | - Stefan Landgraeber
- Department of Orthopedics and Orthopedic Surgery, Universität des Saarlandes - Campus Homburg
| | - Marcus Jäger
- Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim, Contilia GmbH, Mülheim an der Ruhr.,Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Medizinische Fakultät, Essen
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22
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Traven SA, McGurk KM, Reeves RA, Walton ZJ, Woolf SK, Slone HS. Modified frailty index predicts medical complications, length of stay, readmission, and mortality following total shoulder arthroplasty. J Shoulder Elbow Surg 2019; 28:1854-1860. [PMID: 31202629 DOI: 10.1016/j.jse.2019.03.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study was to evaluate the 5-factor modified frailty index (mFI-5) as a predictor of postoperative complications in patients undergoing total shoulder arthroplasty (TSA). METHODS We conducted a retrospective analysis of the National Surgical Quality Improvement Program database for patients undergoing TSA between the years 2005 and 2017. The mFI-5 score, which includes the presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications. RESULTS A total of 18,957 patients undergoing TSA were identified. The mFI-5 was a strong predictor of serious medical complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), discharge to a facility, and readmission (odds ratio ≥ 1.309, P ≤ .001). Length of stay also increased as the mFI-5 score increased (P < .001). However, among all the measured complications, the mFI-5 was the strongest predictor of mortality, with the risk more than doubling for each point increase in the mFI-5 score (odds ratio, 2.113; 95% confidence interval, 1.447-3.086; P < .001). CONCLUSION The mFI-5 predicts serious medical complications, increased length of stay, discharge to a facility, hospital readmission, and mortality in patients undergoing TSA. All of the variables within the mFI-5 are easily obtained through the patient history, allowing for a practical clinical tool that hospitals and surgeons can use to identify high-risk surgical candidates, inform preoperative counseling, and guide perioperative care to optimize patient outcomes.
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Affiliation(s)
- Sophia A Traven
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA.
| | - Kathy M McGurk
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Russell A Reeves
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Zeke J Walton
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Shane K Woolf
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Harris S Slone
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
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23
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Darrow M, Shaw B, Schmidt N, Boeger G, Budgett S. Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1628883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Marc Darrow
- Clinical Research, Darrow Stem Cell Institute, 11645 Wilshire Blvd Suite 120, Los Angeles, CA 90025, USA
| | - Brent Shaw
- Clinical Research, Darrow Stem Cell Institute, 11645 Wilshire Blvd Suite 120, Los Angeles, CA 90025, USA
| | - Nicholas Schmidt
- Clinical Research, Darrow Stem Cell Institute, 11645 Wilshire Blvd Suite 120, Los Angeles, CA 90025, USA
| | - Gabrielle Boeger
- Clinical Research, Darrow Stem Cell Institute, 11645 Wilshire Blvd Suite 120, Los Angeles, CA 90025, USA
| | - Saskia Budgett
- Clinical Research, Darrow Stem Cell Institute, 11645 Wilshire Blvd Suite 120, Los Angeles, CA 90025, USA
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Short-term results of a second generation anatomic short-stem shoulder prosthesis in primary osteoarthritis. Arch Orthop Trauma Surg 2019; 139:149-154. [PMID: 30242565 DOI: 10.1007/s00402-018-3039-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The aim of the study was to evaluate the short-term clinical results of anatomic total shoulder arthroplasty with a short-stem prosthesis in primary osteoarthritis. MATERIALS AND METHODS 65 shoulders with a mean age of 70 years (range 47-85 years) were available for minimum follow-up of 24 months. Clinical outcome was determined by range of motion, Constant score (CS) age and sex-adjusted Constant score (CS%), and subjective shoulder value (SSV). The influence of six different factors (high bone adaptations, age > 65 years, female gender, dominant side, atrophy of the supraspinatus tendon ≥ grade 2, glenoid type B2/B3) on the clinical outcome was assessed. RESULTS At mean follow-up of 37 months (range 24-58 months), the CS improved from 36 ± 8 to 75 ± 12 (p < 0.001). The shoulder flexion (100° ± 21° to 159° ± 19°) as well as the external rotation (3° ± 11° to 43° ± 18°) improved significantly (p < 0.001). Three complications were noted (transient neuropraxia of the radial nerve, subjective instability, hematoma with superficial wound infection) leading to one revision surgery (wound debridement). No stem loosening was observed. High bone adaptation was present in 19 out of 65 shoulders (29%). The clinical outcome was not influenced by high bone adaptations (p ≥ 0.095). Age > 65 years (n = 44) and female gender (n = 38) were associated with worse clinical outcome (p ≤ 0.043). CONCLUSIONS In the short term, the clinical results of this anatomical short-stem shoulder prosthesis are encouraging. A low prevalence of high bone adaptations was found without any influence on the clinical outcome and stem loosening was not observed.
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Lee D, Lee R, Cross MT, Tran A, Kappa J, Moghtaderi S. Low Serum Albumin Levels are Associated with Increased 30-Day Cardiopulmonary Complications, Reoperation, and Readmission Rates Following Total Shoulder Arthroplasty. THE IOWA ORTHOPAEDIC JOURNAL 2019; 39:27-34. [PMID: 32577104 PMCID: PMC7047290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hypoalbuminemia has been associated with several medical complications following surgery in a variety of orthopedic procedures. Hypoalbuminemia has previously been shown to have an increased risk for transfusions, hospital stay longer than three days, and mortality following total shoulder arthroplasty (TSA). This study seeks to further assess the relationship between low serum albumin and morbidity to allow surgeons to both preoperatively optimize patients and assess the risk of surgery prior to TSA. METHODS The American College of Surgeons National Surgical Quality Improvement Program® database was queried to identify 14,494 TSA patients, 6,129 (42.23%) who met inclusion criteria. Patients who had shoulder hemiarthroplasty, revision TSA, or incomplete serum albumin data were excluded. Demographic factors, preoperative comorbidities, and acute complication rates were assessed between hypoalbuminemic (n=485; 7.91%) and a propensity-matched control cohort (n=485), controlling for differences in patient demographics and comorbidities. Multivariate propensity-adjusted logistic regression analyses were used to assess hypoalbuminemia as an independent risk factor for specific postoperative complications. RESULTS Hypoalbuminemic patients undergoing TSA demonstrated significantly higher rates of pulmonary complications (p=0.006), unplanned intubation (p=0.014), DVT/PE (p=0.014), cardiac complications (p=0.033), infectious complications (p=0.025), blood transfusions (p<0.001), reoperation (p=0.007), extended length of stay (> 4 days) (p=0.036), unplanned readmission (p=0.001), and mortality (p=0.025) in the 30-day postoperative period when compared to the propensity-matched control cohort. On multivariate regression analyses, hypoalbuminemia independently increased the risk for pulmonary complications (OR 9.678, p=0.031), blood transfusions (OR 2.539, p<0.001), reoperation (OR 5.461, p=0.032), and readmission (OR 2.607, p=0.007). CONCLUSIONS Hypoalbuminemic patients undergoing TSA had increased rates of overall cardiac and pulmonary complications, unplanned intubations, DVT/PE's, overall infectious complications, increased incidence of blood transfusions, reoperation, extended LOS (> 4 days), readmission, and death. Multivariate analyses demonstrated that low albumin was independently associated with increased risk for pulmonary complications, blood transfusions, reoperation, and readmission. Preoperative albumin levels in patients undergoing TSA may help with preoperative risk stratification and optimization.Level of evidence: III.
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Affiliation(s)
- Danny Lee
- The George Washington University School of Medicine and Health Sciences; The George Washington University
| | - Ryan Lee
- The George Washington University School of Medicine and Health Sciences; The George Washington University
| | - Megan T. Cross
- The George Washington University School of Medicine and Health Sciences; The George Washington University
| | - Andrew Tran
- Department of Orthopaedic Surgery; The George Washington University
| | - Jason Kappa
- Department of Orthopaedic Surgery; The George Washington University
| | - Sam Moghtaderi
- Department of Orthopaedic Surgery; The George Washington University
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Gallacher S, Williams HLM, King A, Kitson J, Smith CD, Thomas WJ. Clinical and radiologic outcomes following total shoulder arthroplasty using Arthrex Eclipse stemless humeral component with minimum 2 years' follow-up. J Shoulder Elbow Surg 2018; 27:2191-2197. [PMID: 30093232 DOI: 10.1016/j.jse.2018.05.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stemless humeral components benefit from less morbidity, better reproduction of the humeral anatomy, ease of revision, and fewer stem-related complications. Encouraging results are available up to 9 years after surgery from the designer's series. This is an independent study of 100 consecutive Eclipse stemless prostheses for osteoarthritis with a minimum 2-year follow-up (range, 2-6 years). METHODS We included only total shoulder arthroplasties performed for osteoarthritis. The primary outcome was the Oxford Shoulder Score (OSS) after 2 years. Secondary outcome measures were change in shoulder range of movement and radiographic analysis of prosthesis size and position. RESULTS The mean OSS at 2 years was 38 of 48, with a mean improvement of +19 points (range, +17 to +22 points; P < .001). There was no significant deterioration in OSS after 3 or 4 years' follow-up. Statistically significant improvement was seen in arm elevation and external rotation (P < .001). There were 5 reoperations-1 for impingement of the biceps stump and 4 revisions to reverse arthroplasty for cuff failure. Of the prostheses, 92% were sized within 2 mm of the anatomic head size, and in 76% of prostheses, the center of rotation was within 3 mm of the native anatomy. An incomplete radiolucent line was present in zone B (around the cage screw) in a single patient at 2 years following surgery. There were no cases of loosening or infection. CONCLUSION The functional and radiographic outcomes of Eclipse total shoulder replacement are excellent. We were able to accurately reproduce the native anatomy in the majority of cases, with no implant loosening, at 2 to 6 years' follow-up.
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Affiliation(s)
- Sian Gallacher
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Huw L M Williams
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrew King
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Jeff Kitson
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Chris D Smith
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - William J Thomas
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK.
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Sheth MM, Sholder D, Abboud J, Lazarus MD, Ramsey ML, Williams GR, Namdari S. Revision of failed hemiarthroplasty for painful glenoid arthrosis to anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27:1884-1890. [PMID: 29754843 DOI: 10.1016/j.jse.2018.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/11/2018] [Accepted: 03/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impending burden of revision shoulder arthroplasty has increased interest in outcomes of revision procedures. Painful glenoid arthrosis following hemiarthroplasty is a common cause of reoperation, and conversion to anatomic total shoulder arthroplasty is one option. METHODS We identified patients who underwent revision of painful hemiarthroplasty to total shoulder arthroplasty over a 15-year period in a single tertiary-care health system. Presurgical and operative data were analyzed for 28 patients who met the inclusion and exclusion criteria. Patients were contacted at a minimum of 2 years' follow-up after revision surgery for functional outcome scores, reoperations, and implant survival. RESULTS The 2- and 5-year implant survival rates were 93% and 86%, respectively. Functional outcomes were obtained from 21 patients with surviving implants. The mean American Shoulder and Elbow Surgeons score, visual analog scale score for pain, and Single Assessment Numerical Evaluation score were 78 ± 20, 2.3 ± 2.6, and 71 ± 24, respectively. The mean Short Form 12 mental and physical scores were 49 ± 10 and 43 ± 9, respectively. Of the patients, 17 (81%) were either satisfied or very satisfied with their outcome. Complications were seen in 10 patients (36%), and 6 patients (21%) required reoperation. CONCLUSIONS Anatomic total shoulder arthroplasty following hemiarthroplasty can achieve successful outcomes and implant survival rates. Given our poor understanding of reverse shoulder arthroplasty longevity, this procedure should remain an option for patients with glenoid arthrosis and an intact rotator cuff.
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Affiliation(s)
- Mihir M Sheth
- Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Daniel Sholder
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Joseph Abboud
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Mark D Lazarus
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Matthew L Ramsey
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Gerald R Williams
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Surena Namdari
- Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
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Kam AW, Lam PH, Haen PSWA, Tan M, Shamsudin A, Murrell GAC. Preventing brachial plexus injury during shoulder surgery: a real-time cadaveric study. J Shoulder Elbow Surg 2018; 27:912-922. [PMID: 29370965 DOI: 10.1016/j.jse.2017.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Brachial plexopathy is not uncommon after shoulder surgery. Although thought to be due to stretch neuropathy, its etiology is poorly understood. This study aimed to identify arm positions and maneuvers that may risk causing brachial plexopathy during shoulder arthroplasty. METHODS Tensions in the cords of the brachial plexuses of 6 human cadaveric upper limbs were measured using load cells while each limb was placed in different arm positions and while they underwent shoulder hemiarthroplasty and revision reverse arthroplasty. Arthroplasty procedures in 4 specimens were performed with standard limb positioning (unsupported), and 2 specimens were supported from under the elbow (supported). Each cord then underwent biomechanical testing to identify tension corresponding to 10% strain (the stretch neuropathy threshold in animal models). RESULTS Tensions exceeding 15 N, 11 N, and 9 N in the lateral, medial, and posterior cords, respectively, produced 10% strain. Shoulder abduction >70° and combined external rotation >60° with extension >50° increased medial cord tension above the 10% strain threshold. Medial cord tensions (mean ± standard error of the mean) in unsupported specimens increased over baseline during hemiarthroplasty (sounder insertion [4.7 ± 0.6 N, P = .04], prosthesis impaction [6.1 ± 0.8 N, P = .04], and arthroplasty reduction [5.0 ± 0.7 N, P = .04]) and revision reverse arthroplasty (retractor positioning [7.2 ± 0.8 N, P = .02]). Supported specimens experienced lower tensions than unsupported specimens. CONCLUSIONS Shoulder abduction >70°, combined external rotation >60° with extension >50°, and downward forces on the humeral shaft may risk causing brachial plexopathy. Retractor placement, sounder insertion, humeral prosthesis impaction, and arthroplasty reduction increase medial cord tensions during shoulder arthroplasty. Supporting the arm from under the elbow protected the brachial plexus in this cadaveric model.
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Affiliation(s)
- Andrew W Kam
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H Lam
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Pieter S W A Haen
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Martin Tan
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Aminudin Shamsudin
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - George A C Murrell
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia.
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Long-term survivorship of stemless anatomical shoulder replacement. INTERNATIONAL ORTHOPAEDICS 2018; 42:1327-1330. [DOI: 10.1007/s00264-018-3779-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
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Cowling PD, Holland P, Kottam L, Baker P, Rangan A. Risk factors associated with intraoperative complications in primary shoulder arthroplasty. Acta Orthop 2017; 88:587-591. [PMID: 28782448 PMCID: PMC5694801 DOI: 10.1080/17453674.2017.1362155] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Increasing numbers of shoulder arthroplasty are performed internationally. The predictors of intraoperative complications when implanting primary shoulder replacements are unknown. We determined the incidence of intraoperative complications during primary shoulder arthroplasty using the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man (NJR), and analyzed the associated risk factors for complications. Patients and methods - NJR data on primary shoulder arthroplasty were scrutinized for intraoperative complications. 2 analyses were performed: the first examined the incidence and predictors of any recorded complication; the second examined the incidence and predictors for intraoperative fractures specifically. Analysis of risk factors was performed using multivariable binary logistic regression modeling. Results - 12,559 primary shoulder arthroplasties were recorded, with an intraoperative complication rate of 2.5%, the majority being fractures (1.6% overall). The incidence of all complications was lower in men (RR vs. women =0.63 (95% CI 0.47-0.84)). Patients undergoing surgery for avascular necrosis (RR =2.3 (1.3-4.2)) or trauma sequelae (RR =1.6 (1.2-2.7)) had a higher risk of complications compared with OA. Patients undergoing a stemmed hemiarthroplasty (RR =1.8 (1.2-2.5)) and reverse shoulder arthroplasty (RR 1.6 (1.1-2.5)) had a higher risk of complications compared with total shoulder arthroplasty. The incidence of all complications was less in patients undergoing resurfacing arthroplasty (vs. total shoulder arthroplasty (RR 0.42 (0.24-0.73)) and when performing the superior approach (vs. deltopectoral (RR 0.56 (0.39-0.80)). Interpretation - This is the first study to use a national data set to examine risk factors for intraoperative complications during all types of primary shoulder arthroplasty, and identifies several previously unrecognized risk factors, such as surgical approach.
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von Engelhardt LV, Manzke M, Breil-Wirth A, Filler TJ, Jerosch J. Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty. World J Orthop 2017; 8:790-797. [PMID: 29094010 PMCID: PMC5656495 DOI: 10.5312/wjo.v8.i10.790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/14/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system.
METHODS Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD® software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score.
RESULTS Both, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc. (P > 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes (P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring.
CONCLUSION TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.
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Affiliation(s)
- Lars V von Engelhardt
- Faculty of Health, University of Witten/Herdecke, Witten 58448, Germany
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
| | - Michael Manzke
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
| | - Andreas Breil-Wirth
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
| | - Timm J Filler
- Department of Anatomy, Heinrich-Heine University of Duesseldorf, Duesseldorf 40225, Germany
| | - Joerg Jerosch
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
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Ingoe HM, Holland P, Cowling P, Kottam L, Baker PN, Rangan A. Intraoperative complications during revision shoulder arthroplasty: a study using the National Joint Registry dataset. Shoulder Elbow 2017; 9:92-99. [PMID: 28405220 PMCID: PMC5384539 DOI: 10.1177/1758573216685706] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 11/29/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND The surgical options for revision shoulder arthroplasty and the number of procedures performed are increasing. However, little is known about the risk factors for intraoperative complications associated with this complex surgery. METHODS The National Joint Registry (NJR) is a surgeon reported database recording information on major joint replacements including revision shoulder arthroplasty. Using multivariable binary logistic regression modelling, we analyzed 1445 revision shoulder arthroplasties reported to the NJR between April 2012 and 2015. RESULTS The risk of developing a complication during revision surgery was greater than primary arthroplasty (5% versus 2.5%). An intraoperative fracture was the most common complication occurring in 50 (3.5%) cases. Nerve injuries were recorded for two (0.1%) patients and vascular injuries for one (0.1%) patient. The incidence of intraoperative fractures was higher in females than males (relative risk = 3.25; p = 0.005). Periprosthetic fracture as an indication for revision carried the highest risk for any complication (relative risk = 3.00, p = 0.06). CONCLUSIONS This is the largest registry study to date investigating the incidence and risk factors for intraoperative complications during revision shoulder arthroplasty. Females have over three times the risk of intraoperative fractures compared to males. This study will help inform surgeons to accurately counsel patients.
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Affiliation(s)
- Helen M. Ingoe
- Department of Orthopaedics and Trauma, James Cook University Hospital, Middlesbrough,UK
| | - Philip Holland
- Department of Orthopaedics and Trauma, James Cook University Hospital, Middlesbrough,UK
| | - Paul Cowling
- Department of Orthopaedics and Trauma, James Cook University Hospital, Middlesbrough,UK
| | - Lucksy Kottam
- Department of Orthopaedics and Trauma, James Cook University Hospital, Middlesbrough,UK
| | - Paul N. Baker
- Department of Orthopaedics and Trauma, James Cook University Hospital, Middlesbrough,UK
| | - Amar Rangan
- Department of Orthopaedics and Trauma, James Cook University Hospital, Middlesbrough,UK
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Leschinger T, Raiss P, Loew M, Zeifang F. Total shoulder arthroplasty: risk factors for intraoperative and postoperative complications in patients with primary arthritis. J Shoulder Elbow Surg 2017; 26:e71-e77. [PMID: 27745807 DOI: 10.1016/j.jse.2016.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study evaluated and identified risk factors for the development of intraoperative and postoperative surgical complications in total shoulder arthroplasty in patients with primary osteoarthritis. METHODS We evaluated patient-specific factors, including age, sex, body mass index, prior nonarthroplasty surgery, smoking, alcohol consumption, and the American Society of Anesthesiologists (ASA) Physical Status Classification System in 275 patients (76 men, 199 women) with an average age of 68 years (range, 51-85 years). We categorized the number and severity of all complications and correlated these results with the patient-specific factors RESULTS: Twenty-seven complications (9.8%) in 275 shoulder arthroplasties were recorded. We identified 22 patients (8%) with category I complications and 5 (2.8%) with category II complications. Patients with an ASA score of 3 showed an increased likelihood of having a surgical complication compared with the control group with ASA scores of 1 and 2 (odds ratio, 4.28; 95% confidence interval, 1.79-10.20; P < .01). Smokers were more prone to surgical complications than nonsmokers (odds ratio, 5.08; 95% confidence interval, 1.96-13.11; P = .02). CONCLUSION Surgical complication rates after anatomic total shoulder arthroplasty in patients with primary osteoarthritis correlate with the patient's overall health status and nicotine consumption. This may be useful for predicting the likelihood of surgical complications and may thus prove important for clinicians to better assess and explain possible risks before surgery.
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Affiliation(s)
- Tim Leschinger
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Germany.
| | - Patric Raiss
- Clinic for Orthopedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus Loew
- Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Felix Zeifang
- Clinic for Orthopedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
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Brolin TJ, Mulligan RP, Azar FM, Throckmorton TW. Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study. J Shoulder Elbow Surg 2017; 26:204-208. [PMID: 27592373 DOI: 10.1016/j.jse.2016.07.011] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/09/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. METHODS Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P < .05 were considered statistically significant. RESULTS No significant differences were found between the ASC and hospital cohorts regarding average age, preoperative American Society of Anesthesiologists score, operative indications, or body mass index. No patient required reoperation. There were no hospital admissions from the ASC cohort and no readmissions from the hospital cohort. Minor complications in the ASC cohort were arthrofibrosis in 2 patients and mild asymptomatic anterior subluxation in 1 patient; the only major complication was in an outpatient who fell 11 weeks after surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. CONCLUSIONS Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA.
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Affiliation(s)
- Tyler J Brolin
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Ryan P Mulligan
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Frederick M Azar
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Thomas W Throckmorton
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
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35
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Is the humeral stem useful in anatomic total shoulder arthroplasty? INTERNATIONAL ORTHOPAEDICS 2017; 41:1035-1039. [DOI: 10.1007/s00264-016-3371-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 12/11/2016] [Indexed: 01/24/2023]
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Garcia GH, Fu MC, Webb ML, Dines DM, Craig EV, Gulotta LV. Effect of Metabolic Syndrome and Obesity on Complications After Shoulder Arthroplasty. Orthopedics 2016; 39:309-16. [PMID: 27220114 DOI: 10.3928/01477447-20160517-03] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/31/2016] [Indexed: 02/03/2023]
Abstract
Metabolic syndrome can adversely affect surgical outcomes. This study evaluated the postoperative outcomes of patients with metabolic syndrome after total shoulder arthroplasty (TSA). A retrospective cohort study of 4751 patients undergoing TSA was conducted with use of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013. Metabolic syndrome was defined as hypertension, diabetes, and body mass index of 30.0 kg/m(2) or greater. Multivariable logistic regression analysis was performed for the outcomes of any postoperative complications and extended length of stay. Patients classified as obese III had a significantly increased risk of extended length of stay (P=.011) compared with control subjects who were of normal weight. In the multivariable adjusted models, compared with nonobese patients, those classified as obese I and obese II had a significantly decreased risk of postoperative complications (odds ratio, 0.84, P=.020, and odds ratio, 0.82, P=.045, respectively), whereas those classified as obese I were less likely to have extended length of stay (odds ratio, 0.79, P=.004). Metabolic syndrome was not a significant predictor of postoperative complications or extended length of stay. Morbidly obese patients undergoing TSA have an increased risk of postoperative complications and extended length of stay. Those classified as obese I and obese II may have a decreased risk of postoperative complications and shorter length of stay. Despite the hypothesized negative effect of metabolic syndrome on outcomes, the overall effect of metabolic syndrome was insignificant. These results are consistent with previous studies on obesity in patients undergoing TSA and may explain why recent studies have not shown differences in the rate of complications after TSA in obese patients with a body mass index of 30 to 40 mg/kg(2). [Orthopedics.2016; 39(5):309-316.].
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Jia X, Chen Y, Qiang M, Zhang K, Li H, Jiang Y, Zhang Y. Compared to X-ray, three-dimensional computed tomography measurement is a reproducible radiographic method for normal proximal humerus. J Orthop Surg Res 2016; 11:82. [PMID: 27422405 PMCID: PMC4947252 DOI: 10.1186/s13018-016-0417-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate comprehension of the normal humeral morphology is crucial for anatomical reconstruction in shoulder arthroplasty. However, traditional morphological measurements for humerus were mainly based on cadaver and radiography. The purpose of this study was to provide a series of precise and repeatable parameters of the normal proximal humerus for arthroplasty, based on the three-dimensional (3-D) measurements. METHODS Radiographic and 3-D computed tomography (CT) measurements of the proximal humerus were performed in a sample of 120 consecutive adults. Sex differences, two image modalities differences, and correlations of the parameters were evaluated. Intra- and inter-observer reproducibility was evaluated using intraclass correlation coefficients (ICCs). RESULTS In the male group, all parameters except the neck-shaft angle of humerus, based on 3-D CT images, were greater than those in the female group (P < 0.05). All variables were significantly different between two image modalities (P < 0.05). In 3-D CT measurement, all parameters expect neck-shaft angle had correlation with each other (P < 0.001), particularly between two diameters of the humeral head (r = 0.907). All parameters in the 3-D CT measurement had excellent reproducibility (ICC range, 0.878 to 0.936) that was higher than those in the radiographs (ICC range, 0.741 to 0.858). CONCLUSIONS The present study suggested that 3-D CT was more reproducible than plain radiography in the assessment of morphology of the normal proximal humerus. Therefore, this reproducible modality could be utilized in the preoperative planning. Our data could serve as an effective guideline for humeral component selection and improve the design of shoulder prosthesis.
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Affiliation(s)
- Xiaoyang Jia
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
| | - Yanxi Chen
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China.
| | - Minfei Qiang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
| | - Haobo Li
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
| | - Yuchen Jiang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
| | - Yijie Zhang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
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Guo JJ, Wu K, Guan H, Zhang L, Ji C, Yang H, Tang T. Three-Year Follow-up of Conservative Treatments of Shoulder Osteoarthritis in Older Patients. Orthopedics 2016; 39:e634-41. [PMID: 27286050 DOI: 10.3928/01477447-20160606-02] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 12/28/2015] [Indexed: 02/03/2023]
Abstract
Little is known about the mid-term results of nonsurgical treatment for shoulder osteoarthritis (OA), especially in a Chinese population. This study sought to determine the efficacy of nonsurgical management in older patients with shoulder OA. A total of 129 conservatively treated unilateral shoulder OA patients who were older than 65 years were evaluated prospectively at the initial office visit and then subsequently at 3, 6, 12, 18, 24, and 36 months later. During the 36-month follow-up period, all patients could receive conventional therapy, such as nonsteroidal anti-inflammatory medication, corticosteroid injection, sodium hyaluronate, and education, at the discretion of treating physicians. Some patients received physiotherapy, rehabilitation training, and a shoulder strap to improve the range of motion and muscular strength training from a physical therapist. Parameters measured included comparative effectiveness of each therapeutic method, visual analog scale (VAS), Simple Shoulder Test (SST), and Short Form (36) Health Survey (SF-36) scores. At 3-year follow-up, most patients had a significant increase from their pretreatment values in pain, self-assessed shoulder function, mental health, and 5 of 8 SF-36 domains. The study showed a decline in SST and VAS at 6 and 12 months after an initial ascent at 3 months, and then it was rescued and continued at 3-year follow-up. Combined therapy could improve symptoms significantly. This study suggests that a conservative approach may be more appropriate and can produce satisfactory mid-term outcomes in selected cases. The findings of this study suggest that conservative treatments should be extended for longer than 12 months before the decision regarding shoulder arthroplasty is made. [Orthopedics. 2016; 39(4):e634-e641.].
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Reverse total shoulder arthroplasty for the management of fractures of the proximal humerus: a systematic review. Musculoskelet Surg 2016; 100:83-91. [PMID: 27316439 DOI: 10.1007/s12306-016-0409-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/26/2016] [Indexed: 02/07/2023]
Abstract
Reverse total shoulder arthroplasty (RTSA) represents a good solution for the management of patients with fracture of the proximal humerus with associated severe osteoporosis and RC dysfunction. A systematic review of the literature according to the PRISMA guidelines was performed matching the following keywords: "reverse total shoulder arthroplasty"; "reverse total shoulder prostheses"; "fractures"; "fracture of the proximal humerus." Medline, EMBASE, Google Scholar, and Ovid database have been screened. Ten studies were considered in the qualitative analysis. No randomized prospective controlled trials have been found. A total of 256 patients received a RTSA for the management of fracture of the proximal humerus. There were 28 males (10.8 %) and 228 females (89.2 %). The mean age of patients was 75.5 ± 2.2 years (range 70-78 years). The mean follow-up period was 27.8 ± 21.8 months range (6-86 months). Overall, the mean Constant score was 56.7 ± 7.6 points (range 44-67.8 points), the mean DASH score was 39.9 ± 6 points (range 31.5-46.8 points), the ASES averaged 70.3 ± 6.8 points (range 65-78 points), and the OSS averaged 28.7 points (range 15-56 points). RTSA restores function and relieves pain in patients with proximal humeral fractures. However, no randomized controlled trials are available to support RTSA versus osteosintesis, anatomical prostheses or hemiarthroprotesis. Further studies are needed to evaluate the effectiveness of RTSA in the management of fracture of the proximal humerus.
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40
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Cisneros LGN, Atoun E, Abraham R, Tsvieli O, Bruguera J, Levy O. Revision shoulder arthroplasty: does the stem really matter? J Shoulder Elbow Surg 2016; 25:747-55. [PMID: 26821560 DOI: 10.1016/j.jse.2015.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 10/07/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of a failed shoulder arthroplasty represents a complex and difficult problem for the treating surgeon, with potential difficulties and complications that are related to the need to remove a well-fixed stem. The aim of this study is to compare the intraoperative complications, postoperative complications, and outcome of revisions from stemmed arthroplasties (STAs) with those from surface replacement arthroplasties (SRAs). METHODS From 2005 to 2012, 40 consecutive revision shoulder arthroplasties were performed at our institute: 17 from STAs and 23 from SRAs. Perioperative events, operation time, blood loss, intraoperative fractures, and use of structural allograft were recorded. Clinical and radiologic outcomes were analyzed. RESULTS Operation time, need for humeral osteotomy, need for structural allograft, and number of intraoperative fractures were significantly higher in the STA group. Blood loss, drop in hemoglobin level, need for blood transfusion, and hospitalization time were also higher in the STA group, but these differences were not statistically significant. Reoperation was performed in 3 patients in the SRA group. A significant clinical improvement was observed in both groups. The Constant score was higher in the SRA group. CONCLUSION Revision of STAs is a more demanding procedure. The postoperative complication rate was slightly higher in the SRA group. The group with revision of SRAs showed slightly better clinical and radiographic results, but there was no statistically significant difference between the groups.
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Affiliation(s)
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ruben Abraham
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Oren Tsvieli
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Juan Bruguera
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
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Garcia GH, Fu MC, Dines DM, Craig EV, Gulotta LV. Malnutrition: a marker for increased complications, mortality, and length of stay after total shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25:193-200. [PMID: 26456427 DOI: 10.1016/j.jse.2015.07.034] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/26/2015] [Accepted: 07/30/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Malnutrition is an established risk factor for postoperative complications. The purpose of this investigation was to determine the overall prevalence of malnutrition in total shoulder arthroplasty (TSA) patients, the differences in prevalence across obesity subgroups, and the overall complication risk of malnourished patients compared with normal patients. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for TSA cases from 2005 to 2013 for this retrospective cohort study. Malnutrition was defined as preoperative albumin concentration of <3.5 g/dL. Rates of postoperative complications were compared between normal and malnourished patients. RESULTS We identified 4,655 TSA cases, with preoperative albumin measurements available for 1681 patients (36.1%). Propensity score adjustment successfully reduced selection bias, with adjusted P values of >.05 for demographics, body mass index, and modified Charlson Comorbidity Index. Of the cohort with albumin measurements, 7.6% of patients were malnourished according to our criteria. Bivariate analysis showed malnourished patients had higher rates of pulmonary complications, anemia requiring transfusion, extended length of stay (LOS), and death (all P < .05). Propensity-adjusted multivariable logistic regression demonstrated that malnutrition was significantly associated (all P < .05) with postoperative transfusion (odds ratio, 2.49), extended LOS (odds ratio, 1.69), and death (odds ratio, 18.09). CONCLUSION The overall prevalence of malnutrition was 7.6%. Malnourished patients were at a significantly increased risk for blood transfusion, longer hospital LOS, and death within 30 days of surgery. Multivariable analysis showed TSA patients with preoperative albumin levels of <3.5 g/dL are at much higher risk for morbidity and death after surgery than patients with albumin levels within normal reference ranges.
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Affiliation(s)
- Grant H Garcia
- Sports and Shoulder Service, The Hospital for Special Surgery, New York, NY, USA.
| | - Michael C Fu
- Sports and Shoulder Service, The Hospital for Special Surgery, New York, NY, USA
| | - David M Dines
- Sports and Shoulder Service, The Hospital for Special Surgery, New York, NY, USA
| | - Edward V Craig
- Sports and Shoulder Service, The Hospital for Special Surgery, New York, NY, USA
| | - Lawrence V Gulotta
- Sports and Shoulder Service, The Hospital for Special Surgery, New York, NY, USA
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Weber-Spickschen TS, Alfke D, Agneskirchner JD. The use of a modular system to convert an anatomical total shoulder arthroplasty to a reverse shoulder arthroplasty. Bone Joint J 2015; 97-B:1662-7. [DOI: 10.1302/0301-620x.97b12.35176] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
If a modular convertible total shoulder system is used as a primary implant for an anatomical total shoulder arthroplasty, failure of the prosthesis or the rotator cuff can be addressed by converting it to a reverse shoulder arthroplasty (RSA), with retention of the humeral stem and glenoid baseplate. This has the potential to reduce morbidity and improve the results. In a retrospective study of 14 patients (15 shoulders) with a mean age of 70 years (47 to 83) we reviewed the clinical and radiological outcome of converting an anatomical shoulder arthroplasty (ASA) to a RSA using a convertible prosthetic system (SMR system, Lima, San Daniele, Italy). The mean operating time was 64 minutes (45 to 75). All humeral stems and glenoid baseplates were found to be well-fixed and could be retained. There were no intra-operative or early post-operative complications and no post-operative infection. The mean follow-up was 43 months (21 to 83), by which time the mean visual analogue scale for pain had decreased from 8 pre-operatively to 1, the mean American Shoulder and Elbow Surgeons Score from 12 to 76, the mean Oxford shoulder score from 3 to 39, the mean Western Ontario Osteoarthritis of the Shoulder Score from 1618 to 418 and the mean Subjective shoulder value from 15 to 61. On radiological review, one patient had a lucency around the humeral stem, two had stress shielding. There were no fatigue fractures of the acromion but four cases of grade 1 scapular notching. The use of a convertible prosthetic system to revise a failed ASA reduces morbidity and minimises the rate of complications. The mid-term clinical and radiological results of this technique are promising. Cite this article: Bone Joint J 2015;97-B:1662–7.
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Affiliation(s)
| | - D. Alfke
- Hannover Medical School, Carl-Neuberg-Str.
1, D-30625 Hannover, Germany
| | - J. D. Agneskirchner
- Go:h (Gelenkchirurgie Orthopädie Hannover), Uhlemeyerstraße
16, 30175 Hannover, Germany
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Multi-patient finite element simulation of keeled versus pegged glenoid implant designs in shoulder arthroplasty. Med Biol Eng Comput 2015; 53:781-90. [DOI: 10.1007/s11517-015-1286-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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MATTEI LORENZO, MORTERA STEFANO, ARRIGONI CHIARA, CASTOLDI FILIPPO. Anatomic shoulder arthroplasty: an update on indications, technique, results and complication rates. JOINTS 2015; 3:72-7. [PMID: 26605254 PMCID: PMC4634807 DOI: 10.11138/jts/2015.3.2.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A shoulder replacement is indicated in patients affected by glenohumeral arthropathy with severely reduced range of motion, persistent pain, especially at night, and loss of strength. There is much discussion in the scientific community about the prosthetic options for these cases: hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. We analyzed the indications for, results of, and complications associated with this kind of surgery, focusing on anatomic arthroplasty and on the concept of modularity.
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Affiliation(s)
- LORENZO MATTEI
- I and II Clinica Ortopedica Traumatologica, CTO, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - STEFANO MORTERA
- I and II Clinica Ortopedica Traumatologica, CTO, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - CHIARA ARRIGONI
- I and II Clinica Ortopedica Traumatologica, CTO, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - FILIPPO CASTOLDI
- I and II Clinica Ortopedica Traumatologica, CTO, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Waterman BR, Dunn JC, Bader J, Urrea L, Schoenfeld AJ, Belmont PJ. Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors. J Shoulder Elbow Surg 2015; 24:24-30. [PMID: 25168345 DOI: 10.1016/j.jse.2014.05.016] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/06/2014] [Accepted: 05/15/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is an effective treatment for painful glenohumeral arthritis, but its morbidity has not been thoroughly documented. METHODS The National Surgical Quality Improvement Program database was queried to identify all patients undergoing primary TSA between 2006 and 2011, with extraction of selected patient-based or surgical variables and 30-day clinical course. Postoperative complications were stratified as major systemic, minor systemic, major local, and minor local, and mortality was recorded. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were derived from bivariate and multivariable analysis to express the association between risk factors and clinical outcomes. RESULTS Among the 2004 patients identified, the average age was 69 years, and 57% were women. Obesity was present in 46%, and 48% had an American Society of Anesthesiologists classification of ≥3. The 30-day mortality and total complication rates were 0.25% and 3.64%, respectively. Comorbid cardiac disease (OR, 85.31; 95% CI, 8.15, 892.84) and increasing chronologic age (OR, 1.19; 95% CI, 1.06, 1.33) were independent predictors of mortality, whereas peripheral vascular disease was associated with statistically significant increase in any complication (OR, 6.25; 95% CI, 1.24, 31.40). Operative time >174 minutes was an independent predictor for development of a major local complication (OR, 4.05; 95% CI, 1.45, 11.30). Obesity was not associated with any specified complication after controlling for other variables. CONCLUSIONS Whereas TSA has low short-term rates of perioperative complications and mortality, careful perioperative medical optimization and efficient surgical technique should be emphasized to decrease morbidity and mortality.
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Affiliation(s)
- Brian R Waterman
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA.
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Julia Bader
- Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX, USA
| | - Luis Urrea
- El Paso Orthopaedic Surgery Group, Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Philip J Belmont
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA
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Brachial Plexus Injuries During Shoulder Arthroplasty. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2014. [DOI: 10.1097/bte.0000000000000030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A convertible shoulder system: is it useful in total shoulder arthroplasty revisions? INTERNATIONAL ORTHOPAEDICS 2014; 39:299-304. [DOI: 10.1007/s00264-014-2563-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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Karelse A, Leuridan S, Van Tongel A, Piepers IM, Debeer P, De Wilde LF. A glenoid reaming study: how accurate are current reaming techniques? J Shoulder Elbow Surg 2014; 23:1120-7. [PMID: 24582954 DOI: 10.1016/j.jse.2013.11.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 11/10/2013] [Accepted: 11/13/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Correct reaming of a degenerative glenoid can be a difficult procedure. We investigated how the quality of the reamed surface is influenced by different reamers, by the surgeon's experience, and by glenoid erosion patterns. MATERIAL AND METHODS Three shoulder surgeons performed reaming procedures with different types of reamers (flat, convex, K-wire guided, and nipple guided) on a series of similarly sized uniconcave and biconcave glenoids. The reproducibility of reaming and the effect of different reamers on different-shaped glenoids were measured and evaluated. RESULTS The center and direction of reaming were constant for all surgeons in the case of type A glenoids. For type B2 glenoids, the center and direction of reaming differed significantly between surgeons. The congruity of the reamed surface was better after flat reaming than after convex reaming. Whether the reamers were guided by a central K-wire or by a nipple had no significant effect on the reamed surface. The experience of the surgeon had no effect on the congruity of reaming. CONCLUSIONS Reaming of a uniconcave glenoid is reproducible, but reaming of a biconcave glenoid seems much more difficult. Erosion and deformity of the glenoid influence the accuracy of reaming the most. Surgical experience plays a less important role. We conclude that there is a need for guidance in reaming of biconcave glenoids.
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Affiliation(s)
- Anne Karelse
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
| | - Steven Leuridan
- Department of Mechanical Engineering, Biomechanics Section, Catholic University of Leuven, Leuven, Belgium
| | - Alexander Van Tongel
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Iwein M Piepers
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Philippe Debeer
- Department of Development and Regeneration, Division of Orthopedics, University Hospital Pellenberg, Pellenberg, Belgium
| | - Lieven F De Wilde
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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49
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Adler D, Siekmann H. [Conservative therapy with a brace for periprosthetic humeral fractures. Clinical and radiological results after 19 months]. DER ORTHOPADE 2014; 43:575-81. [PMID: 24824920 DOI: 10.1007/s00132-014-2312-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to the increasing number of implanted shoulder prostheses following trauma or omarthritis in the recent past, an increase in the occurrence of periprosthetic humeral fractures is to be expected in the future. PROBLEM For type B fractures according to Worland the current literature clearly recommends operative treatment with fixed angle plate osteosynthesis or a long-stemmed cement-free revision endoprosthesis. This article presents a case study on the clinical and radiological results of a conservatively treated periprosthetic humeral fracture (Wright type B or type B2 according to Worland) and a discussion of the current literature. MATERIAL AND METHODS A 70-year-old woman was diagnosed with a periprosthetic humeral fracture with an enclosed fracture endoprosthesis (Wright type B). The operative treatment with fixed angle plate osteosynthesis and the alternative conservative therapy with a brace construct were discussed with the patient. The patient decided on the conservative therapy with regular radiological course control. RESULTS The conservative therapy of periprosthetic type B2 humeral fractures according to Worland using retention in an upper arm brace can lead to excellent radiological and functional results.
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Affiliation(s)
- D Adler
- Universitätsklinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Universität Halle, Halle, Deutschland,
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50
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Johnson CC, Sodha S, Garzon-Muvdi J, Petersen SA, McFarland EG. Does preoperative American Society of Anesthesiologists score relate to complications after total shoulder arthroplasty? Clin Orthop Relat Res 2014; 472:1589-96. [PMID: 24323687 PMCID: PMC3971223 DOI: 10.1007/s11999-013-3400-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/19/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND For hip and knee arthroplasties, an American Society of Anesthesiologists (ASA) score greater than 2 is associated with an increased risk of medical and surgical complications. No study, to our knowledge, has evaluated this relationship for total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (reverse TSA). QUESTIONS/PURPOSES We aimed to assess the relationship between the ASA score and (1) surgical complications, (2) medical complications, and (3) hospitalization length after TSA, reverse TSA, and revision arthroplasty. METHODS We retrospectively analyzed all patients who had undergone TSAs, reverse TSAs, or revision arthroplasties by the senior author (EGM) from November 1999 through July 2011 who had at least 6 months' followup. Of the 485 procedures, 452 (93.2%) met the inclusion criteria. Data were collected on patient demographics, comorbidities, hospitalization length, and short-term (≤ 6 months) medical and surgical complications. Logistic regression analysis modeled the risk of having postoperative complications develop as a function of the ASA score. RESULTS Patients with an ASA score greater than 2 had a greater risk of having a surgical complication develop (p < 0.001; OR, 2.27; 95% CI, 1.36-3.70) and three times the risk of prosthesis failure (ie, component dislocation, component loosening, and hardware failure) (p < 0.001; OR, 3.23; 95% CI, 1.54-6.67). Higher ASA scores were associated with prolonged length of hospitalization (effect size 0.46, p < 0.001), but not medical complications. CONCLUSIONS ASA score is associated with surgical, but not medical, complications after TSA and reverse TSA. The ASA score could be used for risk assessment and preoperative counseling. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christine C. Johnson
- />Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Sonal Sodha
- />Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Juan Garzon-Muvdi
- />Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Steve A. Petersen
- />Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Edward G. McFarland
- />Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA , />c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A672, Baltimore, MD 21224-2780 USA
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